AAPS 104th Annual Meeting

Soft Tissue Three-Dimensional Changes Following Malar Implant Placement:Quantifying the Projection Efficiency Ratio

Victoria Kong, BS1, Martin Kauke-Navarro, MD1, Andrew Salib, BA1, Nikita Singh, BS1, Albert Rancu, BS1, Jake Moscarelli, BS1, Emily Parker, BS1, Michael Alperovich, MD1

1Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT | *Equal contribution

Background

•Malar augmentation is commonly performed in aesthetic and gender-affirming surgeryusing implants

•Quantitative soft tissue effects of malar implants remain poorly described with a lack of objective morphometric data quantifying overlying soft tissue changes in vivo

Objectives

•Provide the first 3D morphometric framework to quantify midfacial projection, surface area, and volume changes

•Apply this framework to characterize soft tissue response following malar implantation across implant size cohorts

•Data Source: Patients undergoing facial feminization surgery (FFS) with bilateral porous polyethylene malar implants (MEDPOR; Stryker) between 2022 and 2025 at Yale New Haven Hospital

Methods

•Postoperative 3D photogrammetry images were registered to baseline using unaltered facial regions and analyzed for projection, surface area, andvolumetric changes within the defined malar region of interest

•Skin thickness at malar eminence was measured from pre-operative CT using 3D segmentation software (Mimics), calculating the maximum perpendicular distance between the cutaneous surface and underlying bone

•Statistical Analysis: Wilcoxon rank-sum and Spearman’s rank correlation tests

•Bilateral measurements averaged per patient

Projection Efficiency Ratio="soft-tissue projection gain (mm)" /"implant thickness (mm)"

Discussion

•MEDPOR malar implants demonstrated an overall 88% projection efficiency ratio

•The 5-mm cohort yielded significantly greater absolute projection (3.67 vs. 2.70 mm; p = 0.019), yet demonstrated lower projection efficiency (73% vs. 90%)

•Potential threshold effect

•As implant volume increases, adjacent soft tissue resistance may attenuate transmission

•A weak, non-significant inverse correlation (ρ = −0.37, p = 0.209) was observed. Thicker soft-tissue envelopes may attenuate implant projection

•Limitations: Small, imbalanced cohorts (n = 13 vs. n = 2); retrospective design; variable follow-up

Conclusions

•MEDPOR malar implants produce a significant, high-efficiency soft-tissue augmentation

•The 5-mm cohort demonstrated greater absolute projection gain (p = 0.019) despite lower efficiency, suggesting a size-dependent threshold effect

•This reproducible 3D framework offers a standardized method for evaluating midfacial alloplastic augmentation outcomes

•This study provides a preliminary quantitative benchmark for preoperative counseling and surgical planning

AAPS 104th Annual Meeting

Three-dimensional Quantification Of Soft Tissue Response Following Malar Implants In Facial Feminization Surgery

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